MEDICARE: LARK HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1720600646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARK HOME CARE

Provider Business Mailing Address
First Line	:	17696 MONTAGE
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-3807
Country	:	US
Telephone Number	:	313-287-3251
Fax Number	:	586-477-4687

Provider Business Practice Location Address
First Line	:	17696 MONTAGE
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-3807
Country	:	US
Telephone Number	:	313-287-3251
Fax Number	:	586-477-4687

Authorized Official
Title or Position	:	OWNER
Name	:	KENITA LARK
Credential	:
Telephone Number	:	313-287-3251

Provider Enumeration Date	:	05/13/2020
Last Update Date	:	05/13/2020

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Directions to “LARK HOME CARE ” Practice Location

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